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A    DISCOURSE 


INFLUENCE   OF   DISEASES 


INTELLECTUAL  AND  MORAL 


POWERS. 


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A  DISCOURSE 


INFLUENCE  OF  DISEASES 


THE  INTELLECTUAL  AND  MORAL  POWERS, 


DELIVERED    AS   AN 


INTRODUCTORY  LECTURE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS, 

IN    THE    CITY  OF    NEW-YORK, 
October  30th,  1848. 

BY  JOSEPH  MATHER  SMITH,  M.  D., 

Professor  of  the  Theory  and  Practice  of  Physic,  and  Clinical  Medicine 


N  E  W-Y  0  R  K  : 

DANIEL  ADEE,   PRINTER,   107   FULTON-STREET, 

18  48. 


New-  York,  Nov.  2d,  1848. 
Dear  Sir  :— 

At  a  meeting  of  the  Students  of  the  College  of  Physicians  and  Surgeons, 
held  on  Wednesday  morning,  Nov.  1st.,  the  undersigned  were  appointed  a  com- 
mittee to  ten*  er  you  the  thanks  of  the  class  for  the  able  introductory  discourse 
pronounced  by  you  on  Monday  evening,  and  to  request  a  copy  of  the  same  for 
publication. 

We  are,  sir,  yours  with  great  respect, 

J.  M.  Cleaveland, 

B.  L.  Budd, 
H.  Gomez, 

A.  H.  Jackson, 

C.  M.  Allin. 
Professor  J.  M.  Smith, 


New-  York,  Nov.  20th,  1848. 
Gentlemen  : — 

Your  note,  informing  me  that  at  a  meeting  of  the  Students  of  the  Col- 
lege of  Physicians  and  Surgeons,  you  were  appointed  a  committee  to  request  a 
copy  of  my  Lecture  delivered  at  the  opening  of  the  College,  for  publication,  I 
duly  received.  Not  anticipating  that  the  Lecture  would  have  been  deemed  wor- 
thy of  such  an  expression  of  approbation,  I  have  hesitated  in  complying  with 
the  request.  Being  desirous,  however,  of  contributing  every  thing  in  my  power 
to  advance  the  knowledge,  and  gratify  the  wishes  of  the  class,  I  have  concluded 
to  revise  the  discourse  at  my  earliest  convenience,  and  place  it  at  the  disposal 
of  the  committee.  » 

With  great  respect, 

I  am,  gentlemen,  your  ob't.  serv't., 

JOSEPH  M,  SMITH. 

Messrs.  J.  M.  Cleaveland, 

B.  L.  Budd, 
H.  Gomez, 

A.  H.  Jackson, 

C.  M.  Allin. 


DISCOURSE 


Gentlemen : 

The  occasion  of  opening  the  present,  or  forty-second 
session  of  this  College,  forms  a  new  epoch  in  its  history. 
A  new  feature  is  to  be  imparted  to  its  character,  by  extend- 
ing the  courses  of  instruction  and  adding  to  the  Faculty 
a  Professor  of  Physiology  and  Pathology.  In  thus  enlarg- 
ing the  means  and  reforming  the  plan  of  collegiate  instruc- 
tion in  medicine,  the  Trustees  and  Faculty  have  manifested 
the  determination  to  elevate  the  standard  of  medical  edu- 
cation. In  this  effort  they  are  supported  by  their  own  con- 
victions of  right,  and  by  the  recommendations  of  the  Amer- 
ican Medical  Association.  In  conformity  with  these  changes 
additional  zeal  and  exertion  will  be  expected  from  the 
teachers:  and  here,  there  is  no  hesitation  in  giving  the 
assurance  that  love  of  ease  will  not  be  permitted  to  inter- 
fere with  their  devotion  to  the  instruction  of  their  pupils. 

In  introducing  the  courses  of  instruction  at  this  time 
before  a  mixed  auditory.  I  feel  myself  called  upon  to  dis- 
course on  some  topic,  connected  with  medicine,  which  may 
be  treated,  for  the  most  part,  without  an  array  of  the  tech- 
nicalities and  principles  of  the  science.  As  one  of  this 
kind,  and  hence  as  appropriate  to  the  occasion,  I  have  se- 
lected for  remark  the  conditions  of  the  mind  in  various 


diseases.  I  am  aware  that  in  announcing  a  theme  so  ex- 
tensive in  its  details,  it  may  occur  to  you  that  the  limits  of 
an  introductory  lecture  will  not  allow  of  anything  more 
than  a  partial  or  synoptical  view  of  it.  Further  than  this 
no  attempt  will  be  made  to  enlarge  on  the  subject. 

In  order  to  exhibit  the  phenomena  of  the  mind  in  dis- 
ease, in  their  distinctive  and  diversified  forms,  it  may  be 
well,  in  the  first  place,  to  advert  to  our  mental  constitution ; 
and,  in  doing  so,  let  it  be  premised,  that  we  regard  the 
mind  as  essentially  immaterial  in  its  nature,  and  endowed 
with  the  property  of  existence,  independent  of  the  body  : 
and  yet,  as  connected  with  the  organism,  so  long  as  it  holds 
an  immediate  relation  with  temporal  things,  being  mani- 
fested and  influenced  by  the  instrumentality  of  the  brain. 
Avoiding  the  question  whether  the  cerebral  apparatus  is  a 
single  organ,  having  an  individuality  of  function,  or  a  con- 
geries or  plurality  of  organs,  each  having  a  special  func- 
tion, we  shall  consider  the  mental  faculties  under  the 
forms  recognised  by  the  generality  of  writers  on  psycholog- 
ical science. 

As  a  preliminary,  then,  to  our  main  design,  it  is  to  be 
observed  that  the  powers  of  the  human  mind  are  divided 
into  two  classes,  to  wit,  first,  the  Intellectual,  and  sec- 
ondly, the  Moral. 

The  intellectual  powers  comprise  the  faculties  of  per- 
ception, attention,  memory,  reflection,  imagination,  and 
judgment  or  reason ;  and  have  for  their  objects  the  cogni- 
zance of  intuitive  truth,  and  the  acquisition  of  a  knowl- 
edge of  the  qualities,  analogies,  and  relations  of  things. 
Their  higher  exercises  are  displayed  in  the  examination 
and  comparison  of  particular  facts,  and  in  deducing  from 
them  general  truths  or  ultimate  principles.  They  enable 
us  to  reflect  on  the  events  of  the  past,  contemplate  the  oc- 


currences  of  the  present,  and  meditate  on  the  probabilities 
and  certainties  of  the  future. 

The  moral  powers  are  equally  well  characterised.  They 
are  certain  conditions  of  the  mind,  usually  denominated  the 
moral  affections,  feelings,  or  faculties.  They  manifest 
themselves  in  various  degrees  of  intensity,  under  the  forms 
of  desire  and  aversion,  hope  and  fear,  joy  and  sorrow,  and 
in  the  active  movements  of  the  will  and  the  conscience. 
They  are  the  source  of  our  mental  sensibilities  and  sympa- 
thies, and  on  them  depend  our  mental  happiness  and  mis- 
ery. They  are  the  chief  determining  motives  of  our  ac- 
tions ;  and  hence  they  constitute  the  most  important  part 
of  our  mental  being. 

But  though  the  intellectual  and  moral  powers  are  differ- 
ent in  their  nature  and  character,  they  are,  nevertheless, 
closely  associated  ;  and,  indeed,  like  the  animal  and  organic 
functions  of  the  body,  are  inseparably  united.  In  a  sound 
and  well  regulated  mind,  both  classes  of  powers  act  in 
beautiful  harmony  and  coincidence.  In  each  department 
there  is  a  supreme  power,  reason  in  the  intellectual  and 
conscience  in  the  moral*  These  presiding  principles  ac- 
complish their  offices  in  modes  totally  dissimilar.  While 
reason,  in  order  to  arrive  at  truth,  labors  through  a  series 
of  logical  deductions,  conscience  intuitively  distinguishes 
right  from  wrong,  and  instantly  announces  it.  In  its  pro- 
cesses of  investigation,  reason  is  liable  to  wander  from  the 
truth,  being  led  astray  by  false  premises  and  erroneous  in- 
terpretations of  phenomena,  and  hence  is  not  a  guide  in 
which  we  can  always  repose  with  confidence.  It  is  not  so 
with  the  operations  of  conscience.  When  enlightened  and 
rightly  exercised,  its  decisions  are  infallible,  and  from  them 

*  See  Philosophy  of  the  Moial  Feelings,  by  John  Abererombie.  M.  D. 


the  mind  seeks  no  appeal.  From  the  correct  action  of 
these  two  leading  principles  of  the  mind,  spring  results 
which  elevate  our  species  far  above  the  lower  animals. 
From  the  exercise  of  reason  man  discovers  evidences  of  de- 
sign and  utility  in  the  works  of  nature;  and  hence  he 
infers  the  existence  of  a  wise,  almighty,  and  beneficent 
Creator.  From  the  stirrings  of  his  conscience  are  evolved 
the  sentiments  of  religion  and  moral  responsibility.  And 
all  this,  on  due  examination  and  reflection,  he  finds  accord- 
ant with  divine  revelation.  In  performing  their  appropri- 
ate functions,  conscience  indicates  the  pathway  of  duty,  and 
reason  urges  the  propriety,  and  displays  the  advantages  of 
pursuing  it. 

The  distinctive  peculiarities  of  the  intellectual  and 
moral  faculties  are  conspicuously  exhibited  in  the  diversity 
of  character  which  arises  from  their  union  in  unequal  de- 
grees of  strength  and  correctness  of  action.  This  diversity 
is  attributable  in  part  to  the  varieties  of  physical  temper- 
ament, but  chiefly  to  a  partial  and  defective  education. 
Reason  and  conscience,  each  in  its  department,  are  the  last 
of  the  mental  powers  fully  developed.  In  the  lowest  de- 
gree of  untutored  nature,  as  in  infancy,  neither  power  ap- 
pears to  be  unfolded.  Whether  there  are  instances  in 
which  one  of  them  may  be  totally  inactive,  and  the  other 
in  healthful  operation,  is  a  question  of  curious  interest.* 
However  this  may  be.  no  fact  is  more  obvious,  than  that 
the  intellectual  faculties  may  possess  vigor  of  the  highest 
order,  evinced  by  splendid  achievements  in  literature,  sci- 
ence, and  the  arts,  and  yet  the  moral  powers  be  not  merely 
undisciplined,  but  deeply  depraved  and  vicious.  And  so 
on  the  other  hand,  the  moral  faculties  may  be  highly  ac- 

*  See  Dr.  Rush's  Inquiry  into  the  Influence  of  Physical  Causes  upon  the  Me- 
al Faculty. 


tive,  and  steadily  regulated  by  the  dictates  of  an  enlight- 
ened conscience,  while  the  intellect  remains,  for  the  most 
part,  uncultivated,  and  the  faculty  of  reason  is  but  feebly 
exercised.  But  such  discordance  of  the  two  classes  of  men- 
tal powers,  are  by  no  means  common.  In  most  persons, 
both  classes  are  so  far  unfolded  and  regulated  as  to  yield 
sufficient  intelligence  to  conduct  the  ordinary  pursuits  of 
life,  and  sufficient  virtue  to  answer  the  requisitions  of  honor 
and  justice,  between  man  and  man. 

With  this  sketch  of  the  intellectual  and  moral  constitu- 
tion of  the  human  mind,  let  us  inquire  in  what  manner  its 
economy  is  affected  by  disease. 

It  is  evident  that  a  distinct  notion  of  the  termination  of 
life  cannot  be  formed  without  a  certain  amount  of  intelli- 
gence. The  inferior  animals  appear  to  be  destitute  of  the 
requisite  powers  of  observation,  and  reason,  to  acquire  such 
intelligence ;  but  man,  an  observing,  reflecting  and  reason- 
ing  being,  soon  learns  the  truth,  that  his  body  must  sooner 
or  later,  yield  to  decay  and  dissolution.  The  knowledge  of 
this  important  truth  is  attained  exclusively  by  the  intellec- 
tual powers ;  but  the  mere  knowledge  of  the  fact,  apart 
from  the  moral  feelings,  occasions  no  pain  or  uneasiness. 
In  this  view,  death  is  no  more  alarming  or  interesting  than 
any  other  event.  It  is  in  the  other  department  of  our 
mental  constitution,  namely,  the  moral,  that  the  idea  of 
death  excites  disturbance.  So  intimately  and  indissolubly 
are  the  functions  of  the  two  classes  of  faculties  connected, 
that  a  movement  in  one  of  them  produces  a  movement  in 
the  other  ;  and  accordingly,  in  most  instances,  no  sooner  ia 
the  idea  of  death  and  its  certainty  deeply  impressed  on  the 
intellect,  than  it  sympathetically  strikes  deep  among  the 
moral  affections,  and  there  excites,  with  other  feelings,  the 


8 


fearful  emotion  so  forcibly  implied  to  in  the  phrase,  "  Death 
is  the  king  of  terrors." 

But  though  such  is  the  mode  in  which  the  knowledge  and 
apprehension  of  death  arise  in  the  mind,  it  is  not  in  every 
individual  of  our  species  that  the  knowledge  exists,  or  the 
apprehension  occurs.  Such  ignorance  and  absence  of  fear 
prevail  in  the  earliest  or  infantile  period  of  life,  and 
in  certain  conditions  of  the  mind  at  a  later  age.  To 
know  nothing  of  dissolution,  would  be  desirable,  were  there 
no  momentous  consequences  after  it.  The  abstract  idea  of 
death  is,  doubtless,  for  wise  and  beneficent  reasons,  concealed 
from  the  lower  animals.  The  fact,  however,  that  life  must 
end,  is  familiar  to  every  human  mind  that  is  fully  and 
soundly  developed ;  and  hence  the  apprehension  of  death  is 
felt  and  acknowledged,  varying  in  degree  from  slight  alarm 
on  the  one  hand,  up  to  terrific  emotion  on  the  other.  The 
circumstances  in  which  the  mind  is  thus  variously  affected, 
in  view  of  the  event  we  are  contemplating,  are  worthy  of 
attentive  remark. 

In  persons  of  mature  age,  and  in  perfect  health,  who  are 
in  circumstances  free  from  apparent  danger,  the  feelings  are 
seldom  disturbed  by  the  thought  that  they  must  pay  the 
debt  of  nature.  It  is  in  sickness  and  incidents  of  peril  that 
death  demands  attention,  and  claims  the  tribute  of  our  fears. 
But  in  such  situations,  there  are  not  unfrequently  circum- 
stances which  repress  apprehension,  or  entirely  dispel  it.  In 
diseases,  the  mind  is  often  as  much  altered  from  its  ordina- 
ry condition,  as  the  body  is  from  its  normal  state.  Com- 
monly, both  the  intellectual  and  moral  powers  are  affected, 
though  sometimes  very  unequally.  In  acute  diseases,  the 
former  are  generally  blunted,  deranged,  or  prostrated. 
They  are  incapable  of  any  protracted  and  profound  processes 
of  thought.     Self  confidence  is  destroyed ;    and  judgments 


requiring  but  slight  efforts  of  reason,  are  formed  with  inde- 
cision and  doubt.  The  imagination  is  sometimes  restless, 
ungovernable,  and  occasionally  extraordinarily  vivid  and 
excursive.  The  memory  is  more  or  less  impaired,  though 
it  sometimes  recalls  ideas,  scenes  and  events  which  had  long 
been  forgotten. 

While  such  are  some  of  the  intellectual  phenomena,  the 
moral  affections  have  often  an  ascendency  which  tkey  seldom 
display  in  health.  Among  those  of  the  most  frequent  occur- 
rence are  anxiety,  despondency,  impatience,  irascibility, 
kindliness  of  disposition,  and  affectionate  tenderness.  The 
conscience  is  quickened,  active,  and  searching ;  regrets  and 
contritions  spring  up ;  and  these,  with  the  fear  of  death  and 
future  retribution,  elicit  resolves  of  reform  and  devotion  to 
the  interests  of  religion.  Sometimes  the  conscience  causes 
little  or  no  alarm,  being  pure  and  tranquil  in  view  of  the 
past,  and  this,  conjoined  with  elevated  devotional  feelings, 
occasions,  amidst  the  anguish  of  disease,  a  high  degree  of 
serenity.  In  some  instances  the  moral  principle  is  obtuse, 
and  its  movements,  in  reference  to  the  former  course  of  ac- 
tions, sluggish  or  powerless.  It  is  also  observable  that  in 
some  forms  of  disease  the  religious  affections,  which  are 
strong  and  unwavering  in  health,  are  occasionally  so  enfee- 
bled, or  suspended,  as  to  leave  the  individual  in  a  state  of 
indifference  to  the  future,  or  to  sink  into  doubt  and  despair. 
Sometimes,  too.  the  moral  feelings  are  so  perverted  as  to 
cause  the  patient  to  utter  profanities  and  obscenities  which 
are  totally  at  variance  with  the  general  purity  of  his 
thoughts  and  words. 

But  there  is  another  moral  feeling  which  is  especially 
active  in  disease — one  that  more  constantly  attends  upon 
every  variety  and  stage  of  sickness,  than  any  other.  It  is 
hope,  "the  most  vital  movement  mortals  feel."     In  health 


10 


this  passion  bears  up  the  mind  under  the  corroding  cares 
and  trials  of  life,  and  sustains  it  in  achieving  exterprises 
that  reach  to 

"  Earth's  loneliest  bounds,  and  ocean's  wildest  shore." 

With  effective  power  it  resists  the  fatal  assaults  of  disease. 
In  sickness  it  exerts  an  antagonistic  force  to  the  depressing 
passions,  and  weakens  the  moral  forces  that  tend  to  the 
destruction  of  life.  It  is,  as  the  poet  Cowley  says,  the  sick 
man's  health. 

Usually,  hope  continues  to  support  the  mind  until  the 
accession  of  the  moribund  state.  But  sometimes,  when  the 
suffering  is  great,  or  has  been  of  long  duration,  or  when  life 
is  embittered  by  misfortunes,  or  rendered  irksome  and  mis- 
erable by  sensual  satieties,  and  sometimes,  also,  when  there 
is  a  firm  and  unvarying  belief  that  the  soul  is  secure  in  its 
prospect  of  happiness,  hope  ceases  to  favor  the  solution  of 
disease,  and  is  often  succeeded  by  a  fervent  desire  for  death. 
In  this  state  of  mind,  patients  sometimes  safely  pass  the 
critical  states  of  disease,  and  not  unfrecjuently,  when  the 
fact  is  announced  to  them,  they  manifest  disappointment 
and  regret. 

In  some  forms  of  disease,  and  particularly  such  as  are 
local  and  malignant,  and  which  do  not  early  disturb  the 
general  functions,  but  slowly  undermine  the  powers  of  the 
constitution,  the  influence  of  hope  is  variable.  Some  indi- 
viduals, in  these  circumstances,  when  convinced  of  the  fatal 
nature  of  their  maladies,  become,  for  the  most  part,  resigned 
to  their  destiny.  In  cases  of  this  kind,  the  mind  may  be 
serene  in  the  waking  state,  though  death  is  the  prevailing 
theme  of  meditation ;  but  often,  in  dreaming,  the  thought 
of  dissolution  is  absent,  and  the  imagination  pictures  scenes 
of  health  and  enjoyment.     Such  mental  visions  may  prove 


11 


the  occasions  of  extremely  distressing  emotions ;  for  in  pas- 
sing from  the  slumbering  to  the  waking  state,  there  is  a  re- 
membrance of  them,  with  a  feeling  of  refreshment,  derived 
from  sleep.  In  these  transient  moments,  there  is  a  forget- 
fulness  of  the  deadly  nature  of  the  malady,  and  a  revival  of 
hope :  but  no  sooner  are  the  reflective  faculties  fully  aroused 
than  the  illusion  vanishes,  and  the  truth  that  death  is  near, 
flashes  through  the  mind,  and  for  a  season,  overwhelms  it 
with  despondency. 

In  some  diseases,  the  effect  of  hope  is  illusory,  removing 
fear  and  giving  promise  of  certain  recovery.  In  all  cases, 
its  recuperative  influence  happily  coincides  with  the  vis 
medicatrix  naturae.  Of  the  sanative  power  of  hope,  physi- 
cians avail  themselves  in  their  management  of  the  sick,  and 
there  is  reason  to  believe  that  life  is  often  preserved  by 
cherishing  and  supporting  it. 

Allied  to  hope,  in  its  remedial  operation,  but  more  ener- 
getic in  its  action  on  the  body,  is  the  influence  of  the  imag- 
ination, excited  by  faith  in  the  curative  efficacy  of  the  means 
employed  for  the  removal  of  disease.  It  is  a  curious  and 
remarkable  fact,  that  the  mind  may  act  so  powerfully  on  a 
part,  or  the  whole  body,  as  to  produce  in  it  the  most  aston- 
ing  effects.  The  phenomena  arising  from  this  mental  in- 
fluence, are  observable  in  producing  diseases,  and  also  in 
correcting  morbid  conditions.  But  in  order  to  readily  ef- 
fect the  salutary  changes,  two  things  are  necessary,  namely, 
first,  a  peculiar  mental  temperament,  a  credulous,  imagina- 
tive, or  superstitious  cast  of  mind  ;  and  secondly,  the  use 
of  some  agent  or  appliance,  which  the  patient  is  made  to 
regard  as  possessing  the  power  of  producing  the  effect  it  is 
desired  to  accomplish.  When  the  temperament  now  referred 
to  does  not  naturally  exist,  it  is  difficult,  if  not  impossible, 
to  excite  the  remedial  power  of  the  imagination,  or  excite 


12 

faith  in  the  efficacy  of  a  therapeutic  prescription.  To  a 
certain  extent,  however,  the  mental  disposition  in  question 
obtains  in  most  persons ;  and  in  sickness,  it  is  frequently 
exalted  to  a  high  degree,  insomuch  that  faith  in  the  vaunt- 
ed nostrums  of  charlatans,  and  certain  popular  remedies,  is 
easily  established.  In  this  way,  it  is  believed,  that  inert 
topical  applications  are  sometimes  the  indirect  means  of 
obviating  or  removing  local  diseases ;  and  that  certain 
drops,  pills,  and  powders,  of  no  salutary  properties,  or,  at 
least,  of  no  adaptation  to  the  diseases  in  which  they  are 
prescribed,  contribute  to  the  cure  of  general  disorders. 
When  the  garrison  at  Breda,  in  1625,  was  on  the  point  of 
surrendering,  on  account  of  its  force  being  weakened  by  the 
prevalence  of  scurvy,  the  Prince  of  Orange  ordered  a  few 
phials  of  sham  medicine  to  be  conveyed  into  the  fortress, 
and  distributed  in  doses  of  a  few  drops  among  the  patients, 
as  an  infallible  specific.  The  effects  were  wonderful. 
"Such  as  had  not  moved  their  limbs  for  a  month,  were 
seen  walking  in  the  streets,  sound,  straight  and  whole. 
Many,  who  declared  that  they  had  been  rendered  worse  by 
all  former  remedies,  recovered  in  a  few  days,  to  their  inex- 
pressible joy."  Perkins  cured  certain  diseases  by  metallic 
tractors;  and  Dr.  Haygarth  of  Bath,  and  Mr.  Smith  of 
Bristol,  in  order  to  ascertain  whether  the  cures  were  effect- 
ed by  the  tractors  or  by  the  power  of  the  mind,  applied  in 
similar  cases,  with  ceremonious  gravity,  instruments  made 
of  wood,  and  painted  to  resemble  the  metallic  tractors,  and 
found  the  results  to  be  equally  favorable.  It  is  through 
the  power  of  the  mind  that  charms,  incantations,  and  amu- 
lets produce  their  sanative  effects.  That  the  benefits  which 
sometimes  follow  the  use  of  homoeopathic  remedies  are  the 
consequences  of  the  dietetic  and  regimenal  treatment  to 


13 

which  patients  are  subjected,  and  of  the  influence  of  the 
imagination,  has  been  proved  by  numerous  and  satisfactory 
experiments. 

The  peculiar  disposition  of  the  mind,  of  which  we  are 
speaking-,  is  not  confined  to  the  low  and  illiterate ;  it  is 
met  with  in  the  higher  and  cultivated  classes  of  society ; 
though  at  present  it  is  less  prevalent  than  in  former  and 
more  superstitious  ages.  "  Pericles,"  says  Plutarch,  "  show- 
ed to  a  friend  who  came  to  visit  him  in  his  sickness,  an 
amulet  which  the  women  had  hung  about  his  neck." 

But  though  we  are  prone  to  ridicule  and  condemn  the 
use  of  means  which  have  no  direct  physiological  action  on 
the  body,  it  is  a  question  of  interest,  no  less  than  of  cu- 
rious inquiry,  whether  the  active  remedies,  appropriately 
and  skilfully  applied,  do  not  in  many  cases,  exert  their  cu- 
rative power  as  forcibly  through  the  medium  of  the  mind, 
as  they  do  immediately  on  the  corporeal  frame.  That  such 
is  sometimes  the  fact,  and  further,  that  the  imagination  co- 
operating with  faith,  is  sometimes  the  sole  efficient  cause  of 
recovery,  when  active  remedies  are  employed,  it  is  as  rea- 
sonable to  suppose,  as  to  admit  that  a  remedy  of  no  power, 
can,  in  the  mode  above  mentioned,  effect  a  cure ;  for,  there 
is  obviously  nothing  in  the  modus  operandi  of  an  efficient- 
medicinal  agent  which  can  interfere  with  the  remedial  ac- 
tion of  the  mind. 

Such  are  some  of  the  mental  phenomena  observable  in 
diseases.  The  causes  to  which  they  are  principally  refera- 
ble, are  the  diversified  forms  of  disease  connected  with  dif- 
ferences of  age,  sex,  temperament,  profession,  habits  of  life, 
and  religious  faith  or  creed.  In  analyzing  particular  cases, 
most  of  these  causes  are  found  to  have  an  influence  on  the 
mind ;  and  hence  an  idea  may  be  formed  of  the  extent  of 


14 


inquiry  which  would  be  necessary  to  determine  the  number 
and  variety  of  mental  conditions  in  sickness;  and  especially 
of  exhibiting  the  slighter  shades  of  difference  between  them. 
The  most  we  shall  attempt,  on  the  present  occasion,  is  to 
notice  some  of  the  more  common  intellectual  and  moral 
phenomena  which  have  their  origin  in,  and  which  in  some 
degree,  aid  in  distinguishing  diseases. 

That  the  state  of  the  mind  in  many  diseases  depends 
more  upon  the  nature  and  seat  of  the  malady  than  upon 
any  other  cause,  is  evident  to  the  most  superficial  observer.. 
This  fact  is  clearly  exhibited  in  the  more  common  disor- 
ders of  the  body ;  and  particularly  in  those  of  the  head, 
thorax,  and  abdomen,  and  such  as  constitute  the  class  of 
essential  fevers.  These  divisions  of  diseases  are  severally 
attended  by  mental  phenomena  somewhat  characteristic; 
and  each  division  has  its  varieties,  as  we  shall  now  proceed 
to  show. 

In  no  disorder  can  the  mind  be  changed  from  its  ordinary 
state,  if  the  functions  of  the  brain  be  not  disturbed:  for 
this  organ  is  the  immediate  instrument  of  intellect  and 
moral  feeling.  As  to  the  kind  of  change  which  the  mind 
undergoes,  much  depends,  not  only  upon  the  nature  of  the 
cerebral  disturbance,  but  upon  the  manner  in  which  it 
arises,  whether  primarily  or  secondarily.  Disease  of  the 
brain  which  is  secondary  or  sympathetic  of  disease  of  some 
other  part  of  the  body,  is  usually  comparatively  mild,  and 
generally  transient  and  variable.  It  may,  however,  by  long 
continuance  or  extraordinary  severity,  arising  from  great 
susceptibility  of  the  brain  to  sympathetic  irritation,  assume 
the  character  of  a  primary  or  idiopathic  affection  of  that 
organ ;  and  when  this  happens,  the  mind  of  course  under- 
goes corresponding  changes.  The  diagnosis  of  such  cases 
is  determined  by  their  early  history.     Moreover,  it  is  im- 


15 


portant  to  remark  that  in  many  diseases  in  which  there  are 
considerable  variations  of  the  mind  from  its  normal  state, 
there  is  no  appreciable  organic  alteration  of  the  brain,  but 
merely  what  is  termed  functional  derangement. 

With  regard  to  primary  or  idiopathic  diseases  of  the 
head,  there  are  no  two  of  them  that  present  precisely  the 
same  train  of  symptoms,  or  the  smae  mental  conditions. 
The  phenomena  by  which  they  are  manifested  consist  of" 
lesions  of  sensation,  motion,  and  mind.  To  the  last  of 
these  we  shall  confine  our  attention. 

In  sudden  and  fatal  seizures  of  apoplexy,  there  is,  to  all 
appearance,  an  instantaneous  prostration  of  the  intellectual 
and  moral  powers.  In  the  language  of  nosology,  there  is 
a  total  loss  of  sense  and  voluntary  motion.  If,  in  the 
slighter  attacks,  there  is  any  consciousness,  it  is  probably 
attended  with  an  indistinct  perception  of  surrounding 
things,  with  perhaps  a  sense  of  impending  danger,  and  a 
strong  disposition  to  sleep.  In  every  pathological  variety  of 
this  disease,  the  mind  is  manifestly  incapable  of  strong 
emotion,  and  recovery  is  rarely  accompanied  with  any  re- 
collection of  what  had  taken  place  during  the  attack. 

A  similar  state  of  mind  occurs  during  the  paroxysms  of 
epilepsy.  In  this  disease,  however,  there  is  sometimes  a 
premonitory  stage,  in  which  the  mental  faculties  are  singu- 
larly aiFected.  The  patient,  besides  being  frequently  un- 
easy, irascible,  or  melancholy,  is  sometimes  instantly  thrown 
into  a  fit  upon  the  starting  up  before  him  of  a  spectre,  the 
appearance  of  which  is  always  a  sure  harbinger  of  a  par- 
oxysm. "  Dr.  Gregory/''  says  Abercrombie,  u  used  to  men- 
tion in  his  lectures  a  gentleman  liable  to  epileptic  fits,  in 
whom  the  paroxysm  was  generally  preceded  by  the  appear- 
ance of  an  old  woman  in  a  red  cloak,  who  seemed  to  come 


16 


up  to  him  and  strike  him  on  the  head  with  her  crutch ;  at 
that  instant  he  fell  down  in  the  fit." 

The  same  general  impairment  of  the  mind  usually  oc- 
curs in  the  severe  forms  of  palsy,  as  hemiplegia,  though 
commonly  in  a  less  degree  than  in  the  diseases  just  men- 
tioned. The  intellectual  faculties  are  frequently  entirely 
prostrated ;  and  often,  when  partially  active,  and  the  dis- 
ease is  protracted,  are  liable  to  become  fatuitous.  The 
memory,  especially,  suffers ;  recent  events  rapidly  pass  into 
oblivion ;  but  what  is  worthy  of  notice,  occurrences  and 
objects,  long  forgotten,  are  sometimes  recalled  in  all  their 
original  freshness.  Such  of  the  moral  powers  as  remain 
excitable,  particularly  in  chronic  cases,  are  those  which  in- 
duce fretfulness,  weeping,  and  childishness.  Instances  of 
paralysis,  however,  are  sometimes  met  with,  in  which  there 
is  no  apparent  diminution  of  intelligence. 

In  other  forms  of  cerebral  disease,  the  phenomena  are 
in  many  respects  different.  Instead  of  there  being  an  ex- 
tinction or  imbecility  of  the  mental  faculties,  there  is  a 
morbid  activity  of  them.  Thus,  in  those  acute  inflamma- 
tions of  the  brain,  described  under  the  terms  of  phrenitis, 
cerebretis,  meningitis,  and  arachnitis,  lesion  of  the  mind  is 
more  common  than  either  lesion  of  sensation  or  motion, 
appearing  sometimes  in  a  mild  form,  and  at  other  times  in 
wild  aberrations  of  reason  and  furious  outbreaks  of  pas- 
sion. In  the  earlier  period  of  these  dangerous  diseases,  the 
deviations  of  the  mind  from  its  sound  state,  appears  to 
consist  in  a  simple  confusion  of  thought  and  apprehension 
of  phrenzy.  After  passing  this  period,  the  mental  opera- 
tions run  into  delirious  excitement,  and  at  length,  dimin- 
ishing in  energy,  are  merged  in  the  stupor  that  attends  the 
close  of  life.  But  though  such  is  the  usual  course  of  fatal 
inflammations   of  the   brain,  it   sometimes  happens  that 


there  ts  of  correct  action  of  the  mind — lucid  in- 

tervals, which  give  hopes  of  recovery.  There  are  cases,  also, 
in  which,  in  the  last  stage,  even  to  the  extreme  verge  of 
life,  a  degree  of  intelligence  remains,  no  less  surprising 
than  curious  to  the  pathologist  who  examines  after  death 
the  extent  of  the  organic'  ravages  which  the  disease  has 
produced  in  the  head. 

The  permanent  changes  produced  in  the  mind  of  those 
wh :  recover  from  inflammation  and  injuries  of  the  brain. 
are  often  exceedingly  grave  in  their  character.  But  some- 
times it  is  otherwise.  In  some  instances  the  mental  powers 
are  greatly  enlarged  and  invigorated.  We  are  told  that  a 
son  of  Dr.  Priestly,  whose  intellect  was  naturally  feeble, 
fell  from  the  window  of  a  two  story  house  and  fractured 
his  skull.  From  this  time  his  intellect  became  greatly  im- 
proved. A  similar  result  occurred  in  the  case  "  of  a  young 
man  of  naturally  very  limited  intelligence,  who  lost  to  the 
amount  of  two  tea-spoonsful  of  brain  by  a  pistol-shot,  be- 
sides considerable  quantities  which  were  discharged  at  sev- 
eral subsequent  dressings.  He  lived  for  two  years  after 
this  occurrence,  with  his  intellect  vastly  improved."*  Though 
inflammation  of  the  brain  in  children  is  extremely  liable 
to  permanently  impair  the  mind,  yet  cases  occur  in  which 
no  such  consequence  is  observable,  and  in  some  of  which 
there  is  reason  to  believe  that  the  influence  of  the  disease 
is  to  invigorate  the  intellect.  It  is  related  of  the  celebrated 
botanist;  De  Candolle,  that  "  in  his  seventh  year  he  suffered 
from  an  attack  of  acute  hydrocephalus,  but  fortunately  con- 
quered a  disease  so  often  fatal  to  childhood,  or  which  in 
other  cases  so  frequently  leaves  behind  a  feebleness  of  the 
mental  powers.     But  the  youth  and  man,  with  his  well  or- 

*  Sewali'a  Esami nation  of  Phventlogy,  p.  76. 


18 


ganized  head,  fitted  for  the  most  difficult  processes  of 
thought,  suffered  no  further  ill  effects  from  this  distressing 
malady.'1* 

There  is  another  group  of  diseases  of  the  brain,  distin- 
guished by  the  general  term  of  Insanity.  Differing  essen- 
tially from  the  comatose  and  inflammatory  maladies  already 
noticed,  in  not  being  usually  attended  by  evident  symptoms 
of  vascular  disorder,  they  present  peculiarities  which  ren- 
der their  nature  exceedingly  obscure.  In  many  cases  the 
only  morbid  phenomenon  observable,  is  simple  derangement 
of  the  mind. 

The  forms  in  which  insanity  appears,  are  so  numerous 
and  diversified,  that  no  investigation,  however  industriously 
pursued,  can  furnish  a  full  and  just  description  of  them. 
In  every  case  there  is  a  unique  individuality  of  character, 
which  must  be  studied  by  itself.  There  are,  however,  cer- 
tain general  forms  of  the  disease  which  may  be  classified ; 
and  to  a  notice  of  these  we  shall  limit  our  attention. 

The  varieties  of  mental  lesion  which  constitute  the  class 
of  insane  disorders,  are  properly  divided  into  two  kinds, 
namely  :  first,  Moral  Insanity,  and  secondly,  Intellec- 
tual Insanity. 

Under  the  head  of  moral  insanity  are  comprehended  all 
conditions  of  the  mind  which  consist  in  morbid  alterations 
of  the  natural  disposition,  habits,  and  affections  or  feelings, 
without  any  decided  hallucination  or  marked  disorder  of 
the  intellectual  faculties. 

In  some  of  its  lighter  forms  or  phases,  this  kind  of  mad- 
ness is  frequently  met  in  our  intercourse  with  the  world, 
It  is  encountered  in  the  domestic  circle,  in  the  saloons  of 
gayety  and  fashion,  in  the  thoroughfares  of  trade  and  in 

*  American  Journal  of  Science  and  Arts,  Vol.  xliv. 


19 


the  halls  of  the  exchange.  Indeed,  so  common  are  the 
-cases  to  which  the  definition  of  this  species  of  insanity  is 
applicable,  that  the  number  is  not  small  of  those  of  whom 
it  can  be  said,  though  they  have  not  been  subjected  to  the 
action  of  a  writ,  de  lunatico  inquirendo,  that  they  have  at 
all  times  enjoyed  the  blessing  mens  sana  in  corpore  sano. 

But  moral  insanity  frequently  appears  in  graver  forms, 
exhibiting  a  great  variety  of  character.  Sometimes  it 
shows  itself  in  the  abandonment  of  ordinary  habits  and 
pursuits ;  in  carelessness  of  one's  own  affairs,  with  random 
indulgence  in  follies  and  gross  sensualities.  Sometimes  it 
is  seen  in  the  form  of  ardent  devotion  to  a  succession  of 
projects,  each  suddenly  conceived  and  embraced,  with,  it  is 
believed,  the  certain  prospect  of  rapidly  amassing  wealth, 
or  advancing  in  honor  and  happiness — and  each  as  suddenly 
given  up  in  disgust.  In  some  cases  there  is  an  uncontrol- 
lable disposition  to  merriment,  boisterous  hilarity,  and 
sportive  and  mischievous  conduct  towards  others.  Occa- 
sionally the  more  striking  phenomena  are  inflated  pride, 
exquisite  vanity,  and  contempt  of  ordinary  things.  Fre- 
quently it  assumes  the  character  of  melancholy  or  deep 
gloom,  attended  with  fondness  for  solitude,  and  forebodings 
of  evil  when  all  around  and  in  prospect  is  inviting  and 
joyous.  A  form  not  uncommon  displays  itself  in  an  unac- 
countable partiality  for  particular  persons,  and  a  dislike  of 
the  nearest  and  dearest  friends,  with  a  disposition  to  revile 
and  injure  them.  The  more  serious  varieties  are  those  in 
which  there  is  a  suicidal  propensity,  or  a  feeling  of  neces- 
sity to  commit  some  dreadful  crime — for  example,  to  de- 
stroy a  certain  individual,  perhaps  a  relative,  as  a  tender 
and  beloved  child — an  act,  the  execution  of  which,  the 
reasoning  power  strongly  opposes,  and  the  conscience 
prevents  by  awakening-  the  feeling  of  horror.     These  re- 


20 


straining  forces,  however,  are  not  always  sufficient  to  curb 
the  strong  propensity.  Sometimes,  as  if  urged  irresistibly 
by  some  demoniac  influence,  the  fatal  deed  is  perpetrated ; 
and  instant  relief  from  the  burning  passion  is  obtained ; 
the  homicide  feels  that  a  part  of  his  destiny  is  fulfilled,  and 
hence  an  emotion  of  satisfaction  spreads  over  his  mind. 
But  such  relief  is  not  always  durable ;  regret  and  remorse 
may  succeed,  and  rankle  long  and  deep  in  the  soul. 

Within  the  limits  of  moral  derangement,  may,  perhaps, 
not  improperly,  be  included  some  of  the  remarkable  eccen- 
tricities and  obliquities  of  human  character.  Such  of 
these  as  are  not  usually  regarded  as  disease,  as  well  as  some 
of  them  that  are  so.  are  among  the  favorite  themes  of  the 
dramatist.  The  ordinary  movements  of  the  mind  are  too 
tame  and  monotonous  to  give  interest  and  animation  to  his 
scenes.  It  is  from  the  excitements  and  perversions  of  the 
moral  affections  that  he  derives  materials  for  his  spirited 
creations ;  and  he  is  regarded  as  the  abler  author,  whose 
graphic  delineations  of  character  come  nearest  to  truth,  with- 
out exceeding  it :  and  he  the  better  actor,  whose  represent- 
ations most  closely  counterfeit,  while  they  "  o'erstep  not  the 
modesty  of  nature."-" 

Moral  insanity  has  a  strong  tendency  to  unsettle  and  de- 
range the  reasoning  powers  ;  and  hence  it  not  unfrequently. 
if  not  always,  precedes  intellectual  insanity.  Of  this  form 
of  madness  there  are  three  species,  namely.  Mania.  Mono- 
mania, and  Dementia. 

In  mania  the  rational  powers  are  generally  deranged. 
There  is  sometimes  great  incoherence  and  rapidity  of 
thought  and  utterance.  The  reasoning  faculty  is  bewil- 
dered :  no  single  subject  long  engages  the  attention.  Oc- 
casionally the  intellect  is  occupied  in  acute  and  logical  ar- 
guments in  relation  to  things  which,  for  the  most  part,  have 


21 


no  existence  but  in  the  imagination.  Frequently  the  mind 
is  thrown  into  furious  ravings,  and  the  body  into  violent 
and  convulsive  movements. 

In  recoveries  from  mania  the  intellectual  powers  are 
often  left  in  an  enfeebled  or  prostrate  state.  But  the  con- 
verse of  this  is  sometimes  observed.  Dr.  Pliny  Earle  says, 
"  It  is  worthy  of  remark,  that  an  enlarged  mental  capacity, 
with  greater  activity  of  intellect,  sometimes  supervenes  up- 
on or  accompanies  a  recovery  from  insanity  f  and  he  adds, 
"  several  cases  of  the  kind  have  come  under  our  observa- 
tion, and  others  are  reported  by  Drs.  Brigham  and  Kirk- 
bride."* 

In  the  second  species,  or  monomania,  the  phenomena  are 
widely  different.  The  mental  derangement  is  partial. 
The  same  train  of  thought  habitually  engages  the  mind  j 
and  though  there  is  a  fixed  hallucination  on  a  single  sub- 
ject, on  all,  or  most  other  matters,  the  reasoning  power  acts 
with  correctness.  The  hallucinations  which  are  classed  un- 
der this  head  are  strikingly  various  in  character.  Some- 
times they  appear  to  be  of  an  agreeable  kind,  though  more 
commonly  they  are  attended  with  moroseness,  misanthropy, 
anxiety,  or  alarm,  amounting  sometimes  to  despair. 

The  attack,  as  just  remarked,  is  frequently  consecutive 
to  derangement  of  the  moral  feelings.  Dejection  of  spirits, 
and  melancholy  broodings,  manifestly  in  many  instances 
owing  to  derangement  of  the  health,  generally  exists  for 
some  time  prior  to  the  disorder  of  the  understanding.  Em- 
barrassed in  its  free  exercise  by  disordered  moral  and  phys- 
ical feelings,  the  intellect  loses  its  discriminating  power, 
and  fixing  itself  on  something,  accidentally  but  forcibly 
suggested  by  the  imagination,  as  a  matter  of  reality,  dwells 

*  American  Journal  of  the  Medical  Sciences,  No.  X.,  April,  1843. 


22 


upon  it  with  unremitting  attention.  The  insane  idea  may 
relate  to  the  patient's  physical  condition,  as  his  personal 
identity;  he  may  fancy  himself  a  king  or  person  of  dig- 
nity, and  as  such,  exact  homage  or  deference  from  all  around 
him ;  or  transformed  into  some  inanimate  substance,  of  a 
kind,  perhaps,  which  is  fragile,  or  easily  injured.  He  may 
believe  there  is  something,  as  an  animal,  within  him,  which 
is  torturing  and  slowly  destroying  him.  "  A  man,  men- 
tioned by  Pinel,"  says  Abercrombie,  "who  had  become  in- 
sane during  the  French  revolution,  imagined  that  he  had 
been  guillotined ;  that  the  judges  had  changed  their  mind 
after  the  sentence  was  executed,  and  had  ordered  his  head 
to  be  put  on  again ;  and  that  the  person  entrusted  with 
this  duty  had  made  a  mistake,  and  put  a  wrong  head  upon 
him/'  The  illusion  may  relate  to  the  patient's  pecuniary 
affairs,  or  to  his  worldly  prospects — to  some  matter  of  con- 
science, as  some  imaginary  crime,  or  some  real  but  trifling 
immorality  in  his  former  life,  which  he  magnifies  and  views 
in  false  and  distorted  relations.  It  may  relate  to  duties 
which  he  fancies  are  imposed  upon  him,  such  as  to  reform 
the  age,  or  remodel  the  system  of  society.  Whether  real 
or  imaginary  crime  is  more  productive  of  monomania,  is  a 
question  which  seems  not  to  admit  of  debate.  A  writer- 
remarks  that  in  his  own  experience,  "  for  every  one  instance 
of  remorse  or  repentance  for  real  guilt,  leading  to  mono- 
mania, there  are  fifty  imaginary  ones."*  Monomania  may 
appear  in  an  intermittent  form — the  illusion  occurring 
sometimes  in  a  quotidian  or  tertian  type.  Not  unfrequent- 
ly  the  mental  distress  is  so  protracted  and  overwhelming- 
that  life  becomes  a  burden,  and  is  ended  by  suicide. 

The  characters  of  the  third  variety  of  intellectual  in- 

*  Med.  Chirurg.  Review,  No.  21,  p.  168. 


23 


sanity,  or  dementia,  or  fatuity  as  it  is  sometimes  called, 
are  also  well  marked.  In  this  the  mind  is  crowded  with 
ideas  which  have  no  rational  connection,  and  which  are 
every  moment  changing.  There  is  no  command  of  the 
power  of  attention,  and  consequently  there  is  no  reflection  \ 
in  most  cases  the  perceptive  faculty  is  deeply  impaired. 
This  form  of  mental  lesion  may  arise  primarily  from 
causes  which  fall  rapidly  and  with  overpowering  force  upon 
the  mind.  Thus,  two  brothers  standing  side  by  side  in 
battle,  one  is  struck  down  dead,  and  the  other  is  instantly 
seized  with  dementia.  But  more  frequently  dementia  is 
consequent  to  chronic  mania,  epilepsy,  paralysis,  and  fever 
complicated  with  inflammation  of  the  brain. 

Dementia  has  been  identified  with  idiocy  ;  but  some 
modern  pathologists  have  made  a  broad  and  just  distinction 
between  them.  Dementia  occurs  when  the  mind  has  been 
developed  and  in  healthful  action :  idiocy,  on  the  contrary, 
is  a  congenital  incapacity  of  the  intellectual  and  moral 
powers,  owing  to  defective  organization  of  the  brain ;  and 
hence  a  person  in  this  condition  can  no  more  be  regarded 
as  diseased  than  one  born  with  a  deformed  arm  or  leg. 

Besides  the  lesions  of  mind  which  have  been  described, 
there  is  another  of  so  frequent  occurrence  that  we  cannot 
avoid  giving  it  a  passing  notice.  I  allude  to  delirium  tre- 
mens. Arising  usually  from  a  specific  cause,  namely,  alco- 
holic drinks,  which  produce  peculiar  effects  on  the  brain 
and  nervous  system,  its  phenomena  are  remarkably  uniform 
and  well  characterised.  The  intellectual  and  moral  powers 
are  all  of  them  thrown  into  a  state  of  morbid  excitement 
and  confusion.  The  more  remarkable  hallucinations  occur 
in  the  imagination  as  it  exists  in  relation  with  the  organ  of 
lision ;  and  hence  they  are  accompanied  by  spectral  illu- 
sions.    Like  the  phantasms  described  by  the  writers  on  ap- 


-24 


paritions  and  demonology,  the  images  in  the  mind's  eye  are 
distinct,  and  remain  sufficiently  long  to  be  contemplated 
with  attention.  Sometimes  they  assume  forms  and  atti- 
tudes that  amuse  tjie  patient.  Thus,  they  may  appear  as 
fairies  in  a  dance,  on  the  floor  of  his  apartment,  the  shapes 
and  costumes  of  which  he  regards  with  curious  attention 
and  pleasurable  emotions.  More  commonly  the  illusions 
are  of  an  alarming  and  fearful  character.  Sometimes  the 
patient  imagines  he  is  sought  for  by  the  officers  of  justice, 
to  answer  for  some  heinous  offence,  of  which  he  declares  he 
is  innocent ;  he  believes  that  a  plot  is  formed  to  rob  and 
murder  him,  or  that  he  is  the  object  of  signal  vengeance. 
Occasionally  he  is  annoyed  by  rats  and  insects,  or  terrified 
oy  hideous  serpents  and  monsters.  Sometimes  he  is  sur- 
rounded by  devils,  each  plying  some  device  to  torment  him. 
In  a  word,  in  no  other  disease  is  the  mind  so  fraug*irt 
with  horrible  images — so  lacerated,  tortured,  and  agonized. 
Well  does  it  deserve  the  expressive  popular  appellation  of 
a  the  horrors."  The  furies  in  tormenting  Orestes  could 
inflict  no  severer  sufferings. 

From  these  general  observations  on  the  conditions  of  the 
intellectual  and  moral  powers  in  disorders  of  the  brain,  we 
proceed  to  remark  that  the  mind  in  certain  maladies  of  the 
chest,  present  some  phenomena  which  are  deserving  of  no- 
tice. 

Usually,  in  these  diseases,  the  mental  faculties  suffer  no 
other  disturbance  than  such  as  attends  ordinary  febrile  ex- 
citement. Delirium  sometimes  occurs:  but  it  is  occasional 
and  transient,  depending  commonly  on  peculiarities  of  tem- 
perament and  exacerbations  of  the  symptomatic  fever,  a 
circumstance  which  in  general  is  sufficient  to  distinguish  it 
from  the  mental  disorder  arising  from  a  primitive  disease 
of  the  brain.      Should  the  sympathetic  irritation   of  the 


25 


brain,  however,  produce  a  serious  injury  of  that  organ. — a 
lesion  that  becomes  fixed  and  independent  of  the  thoracic 
complaint,  the  mind  will  of  course  undergo  the  same  devia- 
tions from  its  sound  state  which  occur  in  idiopathic  cerebral 
affections. 

In  the  later  periods  of  acute  inflammations  of  the  lungs, 
heart,  and  pericardium,  the  mind  often  betrays  much  anx- 
iety and  confused  emotion :  and  as  the  last  hours  of  life 
pass  away,  and  the  aeration  of  the  blood  becomes  more  and 
more  defective,  the  sensorial  power  gradually  fails,  and  the 
mind  sinks  into  inaction  or  hebetude. 

It  is  observed  by  Dr.  James  Jackson  of  Boston,  in  his 
beautiful  memoir  of  his  son.  that  "  the  integrity  of  the  mind 
is  much  oftener  maintained  to  the  last  moments  of  life,  in 
diseases  of  the  thorax,  both  in  acute  and  chronic,  than  in 
those  of  the  abdomen.  It  is."  he  says,  "'not  rare  to  find  pa- 
tients under  pneumonitis  and  phthisis,  rising  in  bed  and 
even  getting  up  out  of  bed  in  the  full  possession  of  their 
minds,  within  the  last  hour  of  life."  And  he  adds.  "  It  is 
in  such  cases  that  we  often  hear  those  calm  and  interesting 
discourses,  upon  their  own  situation  and  in  regard  to  the 
affairs  of  their  friends,  from  patients,  who  are  fully  aware 
how  few  are  the  minutes  which  remain  for  them  in  this 
world."* 

*  According  to  M.  Grisolle.  delirium  in  pneumonia  "  is  of  importance,  not  only 
"because  it  may  arise  from  different  causes,  offering  opposite  indications,  but  also 
because  it  may,  in  some  cases,  give  rise  to  the  belief  in  the  existence  of  a  cere- 
bral disease,  when  in  fast  the  affection  is  seated  in  the  lungs.  And  the  necessity 
of  a  complete  examination  of  the  organs  is  shown  by  the  fact,  that  where  this 
has  been  neglected,  it  has  not  uncommonly  happened  that  persons  have  been 
earried  to  lunatic  establishments  on  account  of  a  temporary  mania,  developed 
during  the  acute  stage  or  the  resolution  of  pneumonia. 

A  third  part  of  such  cases  manifest  themselves  in  persons  addicted  to  drink- 
ing; and  it  has  been  said  that  pneumonia  of  the  apex  especially  gives  rise  to  this 
•symptom ;  but  of  27  patients  exhibiting  delirium.  M.  Grisolle  has  found  the  apex 


26 


In  some  of  the  chronic  forms  of  the  same  diseases,  and 
particularly  when  dropsical  effusions  have  taken  place  m 
the  cavities  of  the  chest,  producing  orthopnea  and  a  feeling 
of  impending  suffocation,  the  physical  sufferings  absorb  the 
attention  of  the  patient,  and  not  unfrequently,  when  they 
are  long  protracted,  occasion  a  strong  desire  for  death.  We 
know  of  few  examples  of  human  malady  which  more  pain- 
fully excites  the  sympathy  of  a  sensitive  bystander,  than 
the  sufferings  here  alluded  to,  especially  when  they  occur  in 
a  person  of  refined  and  cultivated  intellect,  and  of  deep  re- 
ligious feeling.  Chronic  organic  disorders  of  the  heart  and 
large  vessels,  though  they  may  not,  when  stationary  or  tar- 
dy in  their  progress,  impair  the  soundness  and  vigor  of  the 
mind,  are  often  attended  with  great  depression  of  spirits, 
timidity,  frightful  dreams,  and  tremulous  apprehensions  of 
sudden  death. 

But  there  is  no  disease  of  the  thorax  so  uniformly  at- 
tended by  the  same  intellectual  and  moral  phenomena  as 
consumption.  This  disorder,  which  in  some  countries  des- 
troys one  fifth  or  sixth  of  the  population,  differs  essentially 
in  its  nature  from  all  other  diseases  of  the  chest ;  and  what 
is  remarkable,  among  its  characteristics,  is  a  state  of  the 
mind  rarely  observed  in  any  other  malady,  namely,  a  delu- 
sive hope  of  recovery.  This  feature  of  the  complaint  is 
regarded  by  an  eminent  pathologist,  Dr.  Good,  as  distinctly 
pathognomonic,  and  as  such,  it  enters  into  his  definition  of 
the  disease. 

In  the  incipient  period  of  the  pulmonary  affection  there 
is  generally  more  or  less  anxiety  respecting  its  tendency  to 

affected  in  9,  the  base  in  14,  and  the  middle  lobe  in  4;  and  MM.  Anclral  aorf. 
Briquet  have  made  similar  observations.  It  may,  however,  be  stated,  that  dou- 
ble pneumonia  is  more  likely  to  give  rise  to  delirium  than  single."—  British  and, 
Foreign  Med.  Chirurg.  Review,  No.  IV.,  pp.  539,  540,  from  V  Union  Med,- 
icale,  No.  9. 


27 

run  on  to  confirmed  phthisis;  and  if  hemorrhage  from  the 
lungs  occur,  the  alarm  is  greatly  increased ;  but  after  fre- 
quent repetitions  of  the  hemorrhage,  and  as  soon  as  the  pa- 
thological changes  in  the  lungs  have  gone  to  the  point  of 
breaking  down  the  structure  of  these  organs,  and  the  conr 
stitution  is  brought  fully  under  the  influence  of  the  mal- 
ady, the  mind  acquires  a  character  in  a  high  degree  pecu- 
liar. The  reasoning  faculty  remains,  for  the  most  part, 
unimpaired,  being,  in  many  cases,  capable  of  vigorous  ex- 
ercise in  matters  of  literature  and  science :  the  imagination 
is  active,  and  sometimes  more  brilliant  than  in  health. 
The  moral  affections  shine  out  with  unwonted  lustre ;  and 
hope;  though  often  dampened,  allows  no  ordinary  occur- 
rence, no  discouragement,  no  deterioration  of  symptoms  to 
obscure  the  prospect  of  recovery  :  it  sustains  its  ascendency 
in  the  mind  amid  the  ravages  of  pulmonary  disorganiza- 
tion, and  the  exhausting  paroxysms  of  hectic.  Nothing- 
can  break  the  delusion  but  an  extremity  of  suffering  or  the 
agony  of  death. 

The  cases  of  consumption  in  which  an  opposite  state  of 
mind  obtains,  are  generally  complicated  with  a  morbidly 
irritable  nervous  system,  and  a  disordered  condition  of  the 
digestive  organs.  In  such  cases  despondency  may  prevail ; 
but  Grdinarily  something  like  a  neutral  state  is  observed — 
neither  great  alarm  on  the  one  hand  nor  exalted  hope  on 
4he  other.  In  most  instances  of  complicated  phthisis,  how- 
ever, the  moral  feelings,  whatever  may  be  their  general 
tenor,  are  variable.  Where  despondency  is  the  prevailing 
feeling,  hope  occasionally 'breaks  forth  with  cheering  bright- 
ness ;  and  where  despondency  and  hope  appear  to  be  in 
equilibrium  they  nevertheless  are  often  observed  to  alter- 
nately preponderate.     It  is  in  the  purely  unmixed  form  of 


28 


phthisis,  that  a  writer  on  the  subject  remarks,  quoting  and 
changing  a  word  in  the  line  of  a  poet     . 

"  Hope  springs  eternal  in  the  hectic  breast." 

The  inquiry  is  here  naturally  suggested,  whether  hope, 
as  a  sanative  power,  is  not  evolved  and  strengthened  in 
proportion  to  the  proclivity  of  certain  hectic  diseases,  to 
terminate  fatally  ?  That  such  is  the  case  seems  probable, 
from  the  facts  observed  in  various  hectic  diseases,  and  par- 
ticularly in  consumption,  the  most  certainly  fatal  -of  all 
such  diseases,  and  one  in  which  the  passion  in  question  is 
more  exalted  and  more  irrepressible  than  in  any  other  dis- 
order. So  great  is  its  power,  that  there  is  reason  to  be- 
lieve, that,  in  phthisis,  it  often  protracts  life  much  beyond 
the  period  which  the  disorganized  state  of  the  lungs  would 
otherwise  admit.  Moreover,  may  it  not  sometimes,  when 
conjoined  with  some  other  passion  of  an  exciting  and  sus- 
taining character,  act  with  curative  energy  ? 

Passing  from  the  conditions  of  the  mind  in  thoracic  dis- 
eases, let  us  notice  those  which  attend  upon  disorders  of  the 
abdomen.  The  sympathy  existing  between  most  of  the  di- 
gestive organs  and  the  sensorium  is  so  strong  and  readily 
excited,  that  irritation  of  a  certain  kind  occurring  in  the 
former,  is  rapidly  transmitted  to  the  latter,  and  vice  versa. 
If  the  disorder  be  primary  in  the  digestive  apparatus,  it 
sympathetically  excites  a  morbid  state  of  the  brain,  and 
this  by  a  reflex  action  aggravates  the  original  affection. 
These  facts  are  in  general  more  strikingly  manifested  in 
the  chronic  than  in  the  acute  diseases  of  the  abdomen. 
Those  of  the  acute  kind,  as  peritonitis,  gastritis,  enteritis, 
hepatitis.  &c,  are  seldom  attended  by  any  remarkable  in- 
tellectual or  moral  phenomena.     Delirium  may  occur  ;  but 


29 

it  is  usually  of  the  kind  procured  by  simple  febrile  excite- 
ment. When  such  inflammations  terminate  fatally,  the 
mind  often  retains  much  of  its  healthful  energy  to  the  last 
moments  of  life,  enabling  the  patient  to  realize  the  near 
approach  of  death,  and  to  reflect  on  the  momentous  inte- 
rests connected  with  the  solemnity  of  entering  into  another 
state  of  bein^. 

It  is  chiefly  in  the  chronic  affections  of  the  abdomen,. 
and  particularly  in  gastric  and  hepatic  derangements,  that 
the  mind  especially  suffers.  The  more  common  mental 
phenomena  arising  from  these  disorders,  are  anxiety,  des- 
pondency, gloomy  superstition,  disposition  to  magnify  tri- 
fling symptoms  into  dangerous  and  fatal  maladies,  appre- 
hensions of  loss  of  reason  and  of  sudden  death,  and  total  dis- 
like for  all  those  things  which  in  health  were  sources  of 
enjoyment.  These  phenomena,  when  existing  in  a  high 
degree,  especially  in  persons  of  the  melancholic  tempera- 
ment, constitute  that  form  of  disease  denominated  hypo- 
chondriasis— a  disease  closely  allied  to,  if  not  a  variety  of, 
monomania — the  only  difference  between  them  consisting 
in  the  mind  of  the  patient,  in  the  former,  being  morbidly 
concerned  about  his  physical  condition,  and  in  the  latter, 
being  deluded  on  certain  subjects  foreign  to  his  health. 

To  these  observations  it  is  important  to  add,  that  some 
of  the  more  formidable  instances,  not  only  of  moral  but  of 
intellectual  insanity,  though  immediately  depending  upon 
organic  or  functional  lesions  within  the  cranium,  have 
their  Jons  ei  origo  in  derangements  of  the  abdominal  vis- 
cera. From  the  same  sources,  also,  connected  frequently 
with  disorder  of  the  uterine  functions,  spring  some  of  the 
•  curious  and  protean  forms  of  hysteria. 

The  conditions  of .  the  mind  in  Jevers,  strictly  so  called, 
are  almost  of  every  variety.     Generally  these  diseases  pre- 


30 


sent  certain  symptoms  which  are  common  to  them  all :  and 
among  those  more  uniformly  present,  are  such  as  indicate 
disturbance  of  the  functions  of  the  brain.  A  simple  inca- 
pacity of  the  mind  to  act  with  its  accustomed  clearness  and 
steadiness  is  the  only  phenomenon  that  occurs  in  ordinary 
mild  attacks ;  but  between  this  and  the  other  extreme  of 
total  abolition  of  intelligence  in  coma,  are  many  grades  of 
mental  activity  and  varieties  of  aberration. 

In  intermittent  fever,  usually  the  least  dangerous  of  fe- 
brile diseases,  the  intellect  rarely  suffers  beyond  a  slight 
diminution  of  its  healthful  stability  and  vigour,  though 
cases  sometimes  occur  in  which,  during  the  hot  stage,  the 
patient  becomes  extremely  restless,  impatient  and  delirious ; 
u  the  time,"  as  Dr.  Fordyce  remarks,  "  passed  through  seems 
infinitely  long,"  and  no  assurance,  that  the  paroxysm  will 
soon  end  favorably,  can  calm  his  perturbation.  -''Every 
one,"  says  Dr.  Sewall.  "  who  has  observed  cases  of  inter- 
mittent fever,  must  have  been  struck  with  the  increased 
vigor  and  activity  of  the  mind  during  the  hot  stage  of  the 
disease.  Men  of  very  ordinary  capacity  while  under  its 
influence,  often  rise  to  a  decree  of  strength  and  boldness  of 
conception,  and  brilliancy  of  expression  truly  astonishing." 

In  remittent  and  most  other  kinds  of  fevers  which  are 
protracted  for  many  days,  the  mind  is  variously,  and  often 
profoundly  affected.  LTneasy  sensations,  producing  restless- 
ness, jactitation,  and  watchfulness,  are  the  principal  dis- 
tressing phenomena.  In  the  milder  forms,  the  disease  runs 
itg  course  without  occasioning  any  decided  lesion  of  the 
reasoning  power,  or  change  in  the  moral  feelings.  Some- 
times, however,  during  the  exacerbations,  the  mind  is 
thrown  into  great  disorder ;  delirium  occurs,  and  sometimes 
perverseness  of  disposition,  impatience,  obstinacy,  dissatis- 
faction with  every  thing  offered  as  means  of  relief,  and  re- 


31 


jeetion  of  the  kind  assiduities  of  friends  and  physieians. 
The  sleep,  instead  of  being  sound,  is  a  dreaming  state,  the 
same  ideas,  or  confusion  of  images  and  incidents  continue, 
sometimes  for  hours,  to  harrass  the  mind.  Occasionally 
the  patient  is  perplexed  by  an  equivocal  consciousness  of 
his  personal  identity,  or  possessed  with  the  notion  of  the 
certain  fatality  of  his  case.  In  some  instances,  besides  occa- 
sional delirium,  there  are  great  timidity,  tenderness  of  con- 
science, contrition  for  past  actions,  and  alarm  for  the  fu- 
ture; and,  at  the  same  time,  expressions  of  affection  and 
thankfulness  to  those  engaged  in  ministering  to  their  ne- 
cessities and  comfort.  In  other  cases,  the  tenor  of  the 
mind  is  more  uniform,  being,  for  the  most  part,  tranquil, 
and  though  liable  to  variations  of  feeling,  is  upon  the 
whole  happy  and  resigned.  Frequently  in  the  last  stage 
of  typhus  and  of  some  other  fevers,  the  lesion  of  the  brain 
is  so  considerable,  that  patients  lie  on  their  backs  in  a  half- 
waking,  somnolent  or  comatose  state.  In  these  conditions, 
the  mental  powers  are  deeply  deranged  and  prostrated. 
The  delirious  muttering,  catching  at  imaginary  objects  in 
the  air,  and  picking  and  drawing  the  bed-clothes,  betray 
the  confusion  and  illusory  conceptions  of  the  mind.  The 
Moribund  state  is  marked  by  still  greater  exhaustion,  and 
the  patient  dies  unconscious  of  his  last  moments.  It  but 
rarely  happens  in  the  fevers  we  have  mentioned,  that  the 
closing  scene  is  attended  with  sufficient  intelligence  and 
physical  power  to  give  tokens  of  recognition  of  surround- 
ing friends. 

But  there  is  one  species  of  fever  in  which  the  mental 
phenomena  are  so  different  from  those  that  occur  in  the 
more  common  kinds  of  febrile  disease,  that  an  adequate 
wiea  of  them  can  scarcely  be  formed  without  a  practical  ac- 
quaintance  with  the  disorder.    I  refer   to   yellow  fever. 


32 


Though  it  is  not  within  the  design  of  the  present  discourse 
to  give  the  pathological  history  of  any  one  disease,  I  may 
here  remark  that  the  opinion,  once  so  generally  entertained, 
that  yellow  fever  is  but  a  higher  grade  of  bilious  remittent 
fever,  is  now  for  just  reasons  regarded  as  erroneous.  Seve- 
ral of  the  phenomena  that  combine  to  give  a  distinctive 
character  to  yellow  fever,  are  in  a  high  degree  peculiar ; 
and  of  these  there  is  no  one  that  more  strongly  attracts  the 
attention  of  the  physician,  than  the  singular  preservation  of 
the  functions  of  relation.  Attended  from  the  beginning  by 
peculiar,  as  well  as  by  many  of  the  symptoms  common  to 
other  fevers,  the  disease  runs  through  the  stage  of  excite- 
ment in  three  or  four  days,  and  then  sinks  into  a  profound', 
collapse  of  the  organic  or  vital  functions,  leaving  the  mind 
and  voluntary  powers  comparatively  unimpaired.  Not  un~ 
frequently  patients,  pulseless  at  the  wrist  with  deadly  cold- 
ness of  the  extremities,  and  making  no  complaint  but  of 
morbid  sensibility  of  the  stomach,  rise  from  their  beds,  and 
though  somewhat  embarrassed  in  their  movements,  and  ob- 
tuse in  thought,  converse  with  their  friends,  write  letters, 
speak  of  their  business,  and  not  only  imagine  themselves 
convalescent,  but  by  their  intelligence  and  actions  lead 
those  around  them  to  believe  that  they  are  so.  Examples 
of  this  kind  are  called  walking  cases ;  and  the  sudden  and 
unexpected  occurrence  of  death  in  such  deceptive  appear- 
ances of  recovery,  astonish  every  one  not  apprised  of  the 
fact  that  the  disease  in  this  form  is  most  malignant  and 
most  fatal.  Sometimes  the  collapse  is  attended  by  differ- 
ent symptoms,  at  one  time  ending  mortally  in  a  paroxysm 
of  delirium,  and  at  another  in  coma. 

An  examination  similar  to  the  foreo'oins^  might  be  ex- 
tended  to  the  conditions  of  the  mind  in  various  other  dis- 
eases ;  but  as  the  time  allotted  to  this  discourse  is  exhaust- 


33 


ed,  I  can  only  add  that  a  full  exposition  of  the  subject 
would  comprehend  much  that  is  interesting  in  relation  to 
the  mental  phenomena  of  diseases  which  are  modified  by 
the  differences  of  age,  sex,  temperament,  profession,  and 
certain  other  general  causes  to  which  we  have  before  al- 
luded. 

Gentlemen  Students  of  Medicine  : 

I  doubt  not  you  will  agree  with  me,  that  sufficient  has 
been  said  to  render  it  obvious  that  a  medical  education 
should  embrace  a  knowledge  of  the  philosophy  of  the  hu- 
man mind.  We  have  seen  that  the  intellectual  and  moral 
powers  are  subject  to  disturbance  and  derangement  from 
bodily  diseases ;  and  that,  though  the  mind  is  essentially 
immaterial  and  immortal,  when  certain  of  its  faculties  are 
excited,  they  powerfully  affect  the  corporeal  frame,  produ- 
cing effects  which  are  salutary  or  morbid.  Engaged  as  the 
student  is,  for  the  most  part,  in  acquiring  a  knowledge  of 
the  physical  signs,  anatomical  characters  and  treatment  of 
diseases,  he  is  prone  to  neglect,  in  ordinary  cases,  the  con- 
comitant mental  phenomena.  Now  this  should  not  be  so. 
He  should  know  that  to  allay  anxieties,  repress  alarms, 
quell  the  angry  passions,  subdue  obstinacy,  divert  the  imag- 
ination, reinstate  the  reasoning  power,  and  elevate  the 
drooping  and  desponding  spirit,  is  frequently  as  necessary 
to  the  cure  of  a  patient,  as  to  correct  the  disordered  organic 
functions ;  and  that  often  as  much  knowledge  and  skill  are 
wanted  to  accomplish  the  former  as  the  latter. 

In  looking  around  on  the  moral  world,  nothing  is  more  ob- 
servable than  the  fact  that  some  individuals  exercise  a 
vastly  greater  influence  over  their  fellow  men  than  others. 
Such  a  moral  power,  varying  in  degree,  is  seen  in  action  on 
every  side ;  and  every  where  its  agency  is  productive  of 


34 


good  or  evil.  When  it  exists  as  a  vigorous  principle  in  the 
character  of  a  physician,  it  gives  him  an  influence,  as  a 
practitioner,  which  no  amount  of  simple  medical  learning 
can  bestow.  In  the  general  practice  of  medicine  minds  are 
encountered  which  act  independently,  and  which  are  accus- 
tomed to  rule.  To  manage  such  minds  in  disease,  and  es- 
pecially in  circumstances  of  danger  and  alarm,  requires  a 
knowledge  of  the  various  and  best  modes  of  approaching 
them — of  acquiring  their  confidence,  and  of  bringing  them 
under  moral  subjection.  There  are  few  in  the  class  of  ju- 
nior physicians  that  do  not  feel  embarrassment  when  treat- 
ing those  whom  they  are  conscious  are  their  equals  or  supe- 
riors in  the  quality  we  have  in  view.  Where  is  the  young 
physician  or  surgeon,  and  the  question  might  be  asked  in 
respect  to  many  that  are  older,  who  could  make  an  impor- 
tant prescription  or  perform  a  surgical  operation  for  one  of 
the  intellectual  and  moral  qualities  of  Napoleon  or  Sir 
Walter  Scott,  with  the  same  coolness  that  he  would  for  a 
hospital  patient?  It  sometimes  happens  that  patients,  dis- 
tinguished for  their  elevation  and  decision  of  character,  are 
aware  of  the  embarrassed  feelings  of  their  medical  attend- 
ants ;  and  not  unfrequently  endeavor  to  relieve  them  by  en- 
couraging expressions.  Dr.  Johnson,  addressing  the  sur- 
geon who  was  engaged  in  scarifying  his  dropsical  legs,  said, 
"  Deeper,  deeper,  I  want  length  of  life,  and  you  are  afraid 
of  giving  me  pain,  which  I  do  not  value."  In  this  expres- 
sion, however,  it  has  been  thought  he  was  more  influenced 
by  the  fear  of  death  than  a  desire  to  remove  the  fear  of  the 
operator.  Washington  in  his  last  illness,  observing  the 
person  who  was  called  as  a  bleeder,  to  be  agitated,  said 
with  difficulty,  "  Don't  be  afraid ;"  and  Philip  II.  of  Spain 
exclaimed  to  his  physicians,  iC  Are  you  afraid  to  take  a  few 
drops  of  blood  from  a  man  who  has  made  it  flow  in  rivers  f 


35 


I  have  indulged  in  these  concluding  reflections,  in  the 
hope  that  they  may  induce  those  who  resort  to  this  Uni- 
versity for  medical  instruction,  to  study  the  operations  of 
the  mind  in  health  and  disease ;  and  so  to  discipline  their 
own  intellectual  and  moral  powers,  that  they  may  be  pre- 
pared, not  only  to  exert  a  salutary  control  over  the  sick  of 
every  rank  and  character,  but  with  self-possession,  founded 
on  competent  knowledge  and  conscious  moral  integrity,  to 
take  a  commanding  position  in  society,  and  thereby  sustain 
the  dignity  of  their  profession,  and  enlarge  the  circle  of 
their  usefulness. 


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